Organization
L R EVERSOLE A DENTAL CORPORATION
Active
Other names
ORAL PATHOLOGY DIAGNOSTIC SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS R EVERSOLE DDS (PRESIDENT)
(858) 492-9500
Entity
Organization
Contact information
Practice address
9292 CHESAPEAKE DR STE 100, SAN DIEGO, CA 92123-1059
(858) 492-9500
Mailing address
PO BOX 643, POWAY, CA 92074-0643
(858) 513-3889
(858) 513-3893
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Enumeration date
03/24/2006
Last updated
03/22/2011
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